Roentgen Therapy in Hodgkin's Disease

The rapid response of the lymphoblastoma group to x-ray therapy has been well known for many years. Since the lesions originate in lymphoid cells, which are the most sensitive of all body cells to roentgen rays, lymphoblastomas themselves are also very sensitive (1). Certain radiologists would treat these lesions with very light dosages because they are impressed by the good temporary response. Others would give intensive treatment, approaching dosages used for carcinoma. It is likely that the most satisfactory response is obtained somewhere between the two extremes. The method of treatment which has been used at our clinic produces results which, when analyzed, compare very favorably with others so far published. It is our purpose to present statistical data obtained from our records which will give a fairly accurate idea concerning the effectiveness of this method. A series of 185 cases proved by biopsy will be presented. The biopsy specimens were examined by the Department of Pathology, under the supervision of Dr. E. T. Bell. Another group of 53 cases has been analyzed, in which biopsy specimens were examined elsewhere and considered to show the features of Hodgkin's disease. The slides, however, were not available for confirmation. Clinically the lesions in this group strongly indicated the presence of Hodgkin's disease, although we cannot claim them as proved cases. All cases treated in this department from 1926 through 1942 are included and have been followed to the end of December 1945. History The most commonly recognized of the lymphoblastoma group, Hodgkin's disease, took its name from the man who first recognized it in 1832 as a clinical entity, Sir Thomas Hodgkin (2). Seven cases of lymphadenopathy, accompanied by anemia and splenomegaly followed by cachexia and death, were described by him. He felt that the disease was a primary affection of the lymph nodes rather than some secondary infection. Most of the cases described by Hodgkin are now believed to have been tuberculosis or neoplasm, but at least 2 were true examples of what we recognize as Hodgkin's disease. Tissues from one of these cases are still preserved in the museum of Guy's Hospital and have been proved by Herbert Fox (3), with modern microscopic technic, to have the characteristic histologic structure. In 1856 Sir Samuel Wilks (4) added to the original description of Hodgkin and pointed out the frequent involvement of liver, kidneys, and lungs. He clearly distinguished Hodgkin's disease from the leukemias. No detailed description of the microscopic pathology was given until Greenfield (5) referred to the chronic inflammation, marked increase in fibrous stroma, and large number of multinucleated cells. Goldmann (6), in 1892, pointed out the importance of eosinophils, and in 1898 Sternberg (7) described the characteristic giant cells and areas of necrosis. Reed (8), in 1902, correlated the pathological findings with the clinical histories.